DPH presents three‑year evaluation of Assisted Outpatient Treatment showing reduced emergency and incarceration contacts

The San Francisco Department of Public Health reported results from three years of assisted outpatient treatment (AOT) implementation, telling the Health Commission the program has produced measurable reductions in crisis contacts, hospital stays and time spent in jail for participants.

Dr. Angelica Almeida, director of forensic and justice‑involved behavioral health services, summarized activity from November 2015 through December 2018: 321 information calls, 295 referrals and direct outreach contacts with 129 individuals. She said most referrals (92%) come from family members and treatment providers and that the program has been successful in engaging people who are not otherwise connected to care. "We have been able to look at the overall impact of the program over a period of time," Almeida said, reporting a drop in monthly psychiatric emergency services contacts and in average time spent in psychiatric inpatient units and jail. She reported that 31 petitions were filed in court for 20 individuals and noted that 69% of individuals contacted ultimately engaged in voluntary services.

Almeida described program eligibility, referral sources, and the department’s approach to making AOT a last resort that emphasizes voluntary engagement, recovery and trauma‑informed care. She said the program’s court petition penetration rate for court orders is 3.1, higher than 60% of other counties referenced in a Treatment Advocacy Center report. Average length of engagement is about 138 days; Almeida said 96% of individuals connected to services at the time of data collection remained engaged.

Commissioners asked for more disaggregated analysis — for example, separate outcomes for voluntary participants versus court‑ordered cases and clearer long‑range targets for the program. Almeida said DPH can break down the financial savings and outcome measures by voluntary versus court‑ordered cases on request and that the department plans continued outreach to qualified referral parties to increase appropriate referrals.

Commissioners also discussed data comparability across counties and the state reporting process; Almeida noted the state is working to refine annual reporting so counties can be compared more reliably. Commissioners commended the program’s outcomes while noting early controversy during policy adoption and asked for follow‑up analyses, including a clearer set of targets and a breakdown of savings attributable to voluntary versus court‑ordered participants.

The presentation concluded with staff offering to supply additional data tables and future updates to the commission, including a breakdown of the monthly cost‑savings estimates and a clearer accounting of the program’s costs and savings.